An index of vulnerability to coastal change, integrating indices of social vulnerability and exposure to coastal hazards, was created for East Africa to identify ‘areas of priority concern’ for risk reduction. Currently, 22% of East Africa’s coastline and 3.5 million people are at higher levels of exposure to coastal hazards, which would increase, respectively, to 39% and 6.9 million people if mangroves, coral reefs and seagrasses are lost. Madagascar and Mozambique show the largest proportion of the coastline at higher exposure, while Kenya and Tanzania benefit the most from natural coastal protection. Coral reefs protect 2.5 million people from higher exposure, mostly in Mombasa, Zanzibar and Dar es Salaam. Considering Mozambique, Kenya and Tanzania, the latter is the least, and the former is the most vulnerable. Under current conditions, 17 (out of 86) coastal districts are considered ‘areas of priority concern’; four of these are critically exposed as over 90% of their shoreline length are at higher exposure (Zavala, Inharrime, Manhiça and Mandlakaze, all in southern Mozambique). These locations are of critical concern for any present or future coastal development due to the high level of exposure posed to both vulnerable people and investments. Habitat loss would increase the number of ‘priority concern’ districts to 24; some would show great increase in the population exposed (e.g. Pemba and Mossuril in Mozambique). Applying this knowledge to identify where ecosystem-based management should be prioritised to promote social and environmental resilience is timely and urgent in East Africa.